What are CKD sick day rules?
They are rules are designed to reduce the likelihood of Acute Kidney Injury (AKI) and kidney failure – largely in frail elderly people on multiple medications.
So, if such patients become sick and dehydrated (usually secondary to an infection, e.g. urine, chest or gastrointestinal), they are advised to withhold the 7 groups of medications below.
This is because these drugs can precipitate AKI during such illnesses. And if they can be stopped in good time, this may prevent an AKI (rapid onset kidney failure) episode. At worse, AKI in this situation, can cause temporary or permanent dialysis.
This is especially true if the patient is vomiting or has diarrhoea (unless minor), or fevers, sweats and shakes – and are unable to maintain adequate fluid intake.
So. What is a CKD sick day rule – and how are they applied?
So. If you are asked to follow such rules by your doctor, and are unwell with such an infection for longer than 48 hours, please stop these drugs and contact your doctor on that day – to make sure they agree with your action.
- SGLT2 inhibitors, e.g. Dapagliflozin – a diabetes, blood pressure and CKD tablet
- Sulphonylureas, e.g. Gliclazide – diabetes
- Angiotensin-converting enzyme inhibitors (ACEi), e.g. Ramipril – blood pressure
- Diuretics, e.g. Furosemide, Bumetanide, Bendroflumethazide, Spironolactone – water tablets
- Metformin – diabetes
- Angiotensin receptor blockers (ARBs), e.g. Losartan – blood pressure
- Non-steroidal anti-inflammatory drugs (NSAIDs), e.g. high dose Aspirin, Ibuprofen, Naproxen, Diclofenac – painkillers.
Note. If your blood pressure is low, your doctor may also ask you to stop other blood pressure tablets.
‘SSADMAN’ mnemonic
This is a way of remembering which drugs need to be stopped.
- S – SGLT2i
- S – Sulphonylureas
- A – ACEis
- D – Diuretics
- M – Metformin
- A – ARBs
- N – Non-steroidal anti-inflammatory drugs (NSAIDs)
Summary
We have described what are CKD sick day rules. We hope it has been helpful.
Last Reviewed on 30 April 2024